Natural History of Abortive Medication Withdrawal in the Management of Pediatric Medication Overuse Headache

OBJECTIVE: The objective of this study is to document pain scores during withdrawal of abortive medication in patients diagnosed with medication overuse headache. DESIGN: Cross-sectional study. SETTING: Children\u27s National Hospital\u27s Headache Program. SUBJECTS: Patients 6-18 years old who presented to the Headache Clinic at Children\u27s National Hospital with presumed medication overuse headache between March 2017 and March 2019 were consented for participation. METHODS: Patients were instructed to abruptly discontinue overused medications and record their headache characteristics daily in a diary for eight weeks. RESULTS: Fourteen diaries were returned and analyzed at a four-week follow-up visit. 93% of patients were females, with a median age of 14.9 years (SD = 2.0). The average headache intensity upon study entry was 4.7 of 10 (SD = 2.5) and was 3.1 (SD = 2.5) upon study completion. 57% had daily headaches upon study entry. 71% of patients had improved pain intensity from the first to last diary entry. 57% had complete headache resolution at an average of 7.6 days from medication discontinuation (SD = 5.1). Ibuprofen was the most overused medication (71%). CONCLUSIONS: Our findings suggest that medication overuse headache will improve in the majority of pediatric patients who abruptly stop the offending medication(s) in an average of eight days from withdrawal. Average pain intensity was reduced by more than one point among all patients who stopped taking abortive medications. Further larger scale studies on medication withdrawal in pediatric patients with medication overuse headache could help better understand if this management strategy is effective